Laparoscopy is a form of surgery that involves visualizing the interior of the abdominal cavity using an illuminating optical instrument, a laparoscope. The laparoscope and other instruments are introduced into the abdominal cavity through puncture orifices in the abdominal wall.
Laparoscopic procedures are commenced by using a device known as a trocar. The trocar comprises a cannula or trocar sleeve (a hollow sheath or sleeve with a central lumen) and an obturator. The obturator is a solid metal rod with an extremely sharp three-cornered tip and is received in the cannula. The trocar is used to penetrate the abdominal wall, and the obturator is withdrawn from the cannula after the intra-abdominal end of the trocar is in the abdominal cavity. The cannula remains in the body wall throughout the surgical procedure and instruments used during laparoscopic procedures are introduced into the abdomen through it. Trocars, including cannulae, are available in different sizes to accommodate various surgical needs.
Laparoscopy traditionally has been used almost exclusively for gynecological surgery, but physicians specializing in other fields have begun to recognize the diagnostic and operative value of such procedures. The advantages of laparoscopic surgery include: procedures may be performed on an outpatient basis; surgeons are given the opportunity to view intra-abdominal viscera without performing a laparotomy, a large incision of the abdominal wall; small puncture wounds are created rather than large incisions, lessening trauma; incision sites for laparotomies may be determined; patient and insurer medical costs are reduced by shorter hospital stays; and postoperative patient discomfort, with recovery times measured in days as opposed to weeks, is lessened. As these advantages are being perceived, the number and variety of laparoscopic procedures being performed is increasing.
There is substantial interest in and need for providing task specific surgical instruments particularly adapted to general and neurological surgical procedures now being performed laparoscopically. Because laparoscopy is an evolving specialty within the field of general surgery, currently available instruments inadequately meet the needs of laparoscopic surgeons.
Absorbent materials, instruments having an associated absorbent structure or instruments for grasping and manipulating absorbent materials are used frequently in surgical procedures. Gauze, fabrics, cotton, sponges, and other synthetic or natural materials are representative of the absorbent materials. With regard to instruments used in conjunction with such materials, examples include hemostats, tweezers or rod-like instruments having a slot or other absorbent material receiving structure near one end. Such materials and instruments may be used for cleansing cavities, applying therapeutic materials, absorbing fluids, and sampling.
The superficial use of absorbent materials and instruments for handling them is well known. They may be used with ease in the body of a patient through the relatively large incisions made during typical general surgical procedures. Clearly, however, absorbents cannot be used in the typical fashion in laparoscopic procedures because any absorbent or instrument intended for intra-abdominal use must be introduced into the abdominal cavity through a cannula, as outlined above.
Elongated swabs, generally comprising a slender rod with an absorbent material carried at one end, are known. Urethral swabs provide one example. However, even this type of swab would present difficulties if use in laparoscopic procedures was attempted. One problem is that the absorbent material carried at the end of a swab may be separated from the rod to which it is attached. If this occurs in a body cavity opened by a relatively large incision, it is not difficult to retrieve the absorbent material from the body cavity through the incision. In laparascopy, when working exclusively through a cannula of relatively small diameter, the level of difficulty of retrieving a bit of absorbent material is multiplied many times.
Another problem with trying to use or adapt existing swabs for use in laparoscopic use is that it is difficult and time consuming to present a sterile absorbent material into the body cavity, because it is difficult to grip or attach a piece of absorbent material to the rod of existing swab or swab-type instruments.
Further complications are that the typical absorbent materials and instruments for handling them are impossible or difficult to insert into a cannula. Even if such materials and instruments are able to be inserted, they may become lodged or caught on portions of the cannula, and they will be extremely difficult to withdraw from the abdominal cavity through the cannula, particularly if the size or volume of the absorbent material is expanded by the absorption of fluids. Additionally, using known absorptive materials and instruments intra-abdominally may interfere with the surgeon's field of vision.
Clearly there are many problems unaddressed by currently available absorbent instruments for use during laparascopy. Accordingly, there is a need for a safe, inexpensive, efficient, semi-disposable swab for use in laparoscopy.